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PubMedDate not supplied

Augmentation of cardiopulmonary baroreflex control of forearm vascular resistance in borderline hypertension.

Arterial baroreflex control of heart rate is impaired in young men with borderline or mild hypertension. Despite this impairment, these subjects often have exaggerated increases in vascular resistance during orthostatic stress. We considered the possibility that this exaggerated reflex vasoconstriction might reflect augmented cardiopulmonary baroreflex control of vascular resistance in borderline hypertension (BHT). Accordingly, we studied cardiopulmonary baroreflex control of forearm vascular resistance in nine BHT men with blood pressure intermittently above 150/90 mm Hg and in seven normotensive (NT) men. Cardiopulmonary baroreceptor input was reduced with lower body negative pressure (LBNP-5 to-20 mm HG), which decreases cardiac filling pressures. Baseline mean arterial pressure was 99 /+- 3 mm Hg (mean /+- SE) in BHT vs 83 /+- 2 mm Hg in NT (p less than 0.05). Baseline forearm resistance was also higher in BHT than in NT: 19 /+- 2 vs 13 /+-1 mm Hg/ml/min/100 ml or units (p less than 0.05). Reflex increases in forearm resistance during LBNP were greater (p less than 0.05) in BHT than in NT 8.6 /+- 1.7 vs 4.5 /+- 1.1 units during LBNP-20). Increases in arterial pressure and forearm resistance during a cold pressor test were not significantly different in the two groups. Thus, the augmented response to LBNP could not be attributed to a nonspecific influence of increased baseline resistance or a generalized abnormality in reflex control. In summary, the results of this study suggest that there is augmentation of the tonic inhibitory influence of cardiopulmonary baroreceptors in humans with BHT.

Adult↗
PubMed2000

Oesophageal syncope.

Oesophageal syncope is loss of consciousness on swallowing, which is thought to be associated with an abnormal vagovagal reflex that leads to transient bradycardia. Patients with this potentially lethal condition may present to neurologists, cardiologists or gastroenterologists. It may be associated with cardio-active drug therapy, previous myocardial infarction, or with an organic lesion of the lower oesophagus. Barium and manometric studies, in association with ECG monitoring, should, therefore, be carried out in all cases. In many patients, however, it appears to be a functional abnormality for which no cause can be determined. In the absence of a condition necessitating surgical correction, medical therapy in the form of anticholinergic or sympathomimetic agents is occasionally helpful. Total denervation of the affected portion of the oesophagus has successfully prevented further symptoms, but insertion of a programmed cardiac pacemaker is currently the definitive treatment of choice.

Deglutition↗
PubMed1990

Periventricular-intraventricular hemorrhage, sonographic localization, phenobarbital, and motor abnormalities in low birth weight infants.

A total of 228 low birth weight (less than 1750 g), mechanically ventilated infants with and without periventricular-intraventricular hemorrhage were examined at 18 months corrected age to assess the relationship between cranial ultrasonographic findings and specific motor abnormalities. All infants were previously enrolled in a double-blind, randomized, prospective clinical trial of phenobarbital prophylaxis against periventricular-intraventricular hemorrhage. Ultrasonographic abnormalities on the scans performed between 7 and 13 days of life were categorized as germinal matrix hemorrhage, lateral ventricular hemorrhage, parenchymal hemorrhage, ventriculomegaly, and any hemorrhage. Regardless of anatomical location, periventricular-intraventricular hemorrhage was associated with an increased risk for developing motor abnormalities. Hypertonia and hyperreflexia/ankle clonus were most common. No abnormal motor findings distinguished unilateral from bilateral germinal matrix hemorrhage and lateral ventricular hemorrhage or between phenobarbital and placebo treatment. None of the 5 infants with parenchymal hemorrhage had spastic cerebral palsy. Ventriculomegaly was associated with a fivefold increase in risk for spastic cerebral palsy and delayed walking and a threefold increase for hypertonia and hyperreflexia/clonus. The results suggest that ventriculomegaly, observed even as early as the first week of life, might be a significant antecedent of later motor abnormalities among the survivors of periventricular-intraventricular hemorrhage.

Cerebral Hemorrhage↗
PubMed1977

Experimental evaluation of watersoluble contrast media for myelography.

An experimental method for testing contrast media for myelography was developed and used to compare three watersoluble contrast media, iocarmate meglumine, iothalamate meglumine and metrizamide after suboccipital myelography in 120 rabbits. A further 71 rabbits served as controls. Iocarmate and iothalamate caused vigorous convulsions; metrizamide did not. Examination of the CSF revealed an acute pleocytosis after installation of the contrast media and after cisternal puncture with injection of hypertonic saline. Histological examination of the spinal cord, nerve roots and meninges revealed pathological changes in 1 or 32 unoperatec controls (3%). Leucocyte infiltrations were found in the meninges, nerve roots and spinal cord of about 20% of the animals after myelography, after cisternal puncture without injection or with injection of hypertonic saline. There were no significant quantitative differences between the experimental groups. Degenerative changes were seen only after myelography. No meningeal fibrosis was demonstrated. An abnormal leucocyte count in the primary CSF influenced the incidence of histological changes, indicating that only rabbits with CSF cell counts within normal limits should be used in future experiments.

Animals↗
PubMed2005

[Recurrent Miller-Fisher syndrome].

INTRODUCTION: Miller-Fisher syndrome (MFS) is a rare auto-immune post-infectious syndrome, characterized by an ataxia, an ophthalmoplegia and a generalized areflexia. It is considered as a clinical variant of Guillain-Barré syndrome (GBS). MFS is correlated with the presence of anti-GQ1b antibodies, elevated cerebrospinal fluid (CSF) protein levels, presence of mostly sensitive electrophysiological abnormalities and for some authors central involvement with increased signal intensity of brainstem and cerebellum on MRI. Recurrent MFS is extremely rare with only 21 cases since the first description in 1970. CASE REPORT: A 54-year-old women presented MFS with two episodes in 19 years. Clinically, the first episode was a "classical" MFS, and the second an extensive MFS with tetraparesis and respiratory failure. CSF protein levels and cerebral MRI were normal. Anti-GQ1b antibodies were strongly positive and anti-GM1, anti-GM2 antibodies were slightly positive, campylobacter jejuni serology was negative. Electromyography showed isolated sensory abnormalities in median nerves territory. CONCLUSION: We report a new case of recurrent MFS with unusual clinical, biological and electrophysiological features.

Antibodies↗
PubMed1988

Perinatal correlates of major and minor neurological dysfunction at school age: a multivariate analysis.

A prospective study was carried out on 747 infants: 147 neurologically abnormal, 300 with mild neurological abnormalities and 300 normal infants. They were re-examined at nine years of age, with special attention being paid to minor neurological dysfunction (MND). Extensive data on obstetrical history, neonatal course and interval complications were collected. Neurological handicap was not found on follow-up in the group of normal newborns. Other than neonatal neurological abnormality, risk factors contributing significantly to later handicap were low one-minute Apgar scores, a disturbed neonatal course, low social-class and interval complications; obstetrical events were conspicuous by their absence. Two aetiologically and clinically distinct kinds of MND were distinguished on the basis of a neurological cluster profile: MND-1 (one or two abnormal clusters) was only associated with a birthweight below the 2.3 centile and male gender, and MND-2 (more than two abnormal clusters) was associated with neonatal neurological findings, social class, obstetrical optimality score and gender.

Child↗
PubMed2004

Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations.

Patients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinal involvement are posturography and vestibular evoked myogenic potentials (VEMPs). While posturography cannot be performed in every subject requiring minimal stance control, VEMPs do not require any specific skill on the part of the subjects and they may be investigated in all patients able to sit. VEMPs were recorded for 40 patients (17 men, 23 women; mean age 38 years, range 17-71 years) fulfilling diagnostic criteria of clinically defined MS, by means of rarefaction clicks, recording modulation of sterno-cleido-mastoideus tonic contraction saccule-mediated modulation. VEMPs were found to be abnormal in 28 of 40 patients. In 18 of the cases the VEMPs were asymmetric, i.e., had a prolonged latency on one side. In six cases latency was increased on both sides (mean delay 4.1 ms). In four subjects VEMPs were absent on one side. Concordance with clinical findings of presence/absence of brainstem involvement was found in 55% and with MRI findings in 65% of the cases. Abnormal VEMPs indicated brainstem dysfunction in four patients (10%) with normal MRI and no specific clinical signs.

Adolescent↗
PubMed2004

Baroreceptor reflex in heart failure.

Congestive heart failure is a syndrome that is usually initiated by a reduction in pump function of the heart, i.e. a decrease in cardiac output. Initially, a reduction in cardiac output leads to unloading of baroreceptor reflex that, in turn, increases heart rate through vago-sympathetic mechanisms and total peripheral resistance via an increase in sympathetic outflow to vascular beds. In this review we are thinking on how baroreceptor reflex plays a role in the abnormal control of the circulation in heart failure. This review and our recent studies suggest that: (1) baroreceptor reflex is blunted in heart failure; (2) central angiotensin II and reactive oxygen species play an important role in blunted baroreceptor reflex; (3) cardiac sympathetic afferent stimulation and chemoreceptor reflex inhibit baroreceptor reflex; and (4) exercise training normalizes abnormal reflexes in the heart failure state.

Angiotensin II↗
PubMed1988

Ocular autonomic nerve function in proliferative diabetic retinopathy.

Ocular autonomic nerve function was assessed in 28 diabetic patients with proliferative retinopathy (PDR) and 61 age- and sex-matched control subjects, by measurement of the pupil cycle time and determination of autonomic denervation hypersensitivity of the iris. Sustained pupil cycle time was absent in 88.5 per cent of PDR compared with 9.8 per cent of control subjects (p less than 0.001). Pupil constriction in response to 2.5 per cent methacholine--indicative of parasympathetic denervation hypersensitivity--was significantly increased in PDR (p less than 0.001), whilst pupil dilation in response to 0.5 per cent phenylephrine--indicative of sympathetic denervation hypersensitivity--was also significantly higher in PDR (p less than 0.001). Pupil reflexes were abnormal in 88.5 per cent of diabetics with proliferative retinopathy, with established autonomic denervation hypersensitivity in 57 per cent of patients.

Adult↗
PubMed1979

Spasticity due to phenytoin toxicity.

A young epileptic presented with spasticity as well as ataxia, diplopia and nystagmus; his serum phenytoin level was very high. All the abnormal signs disappeared after withdrawal of phenytoin. Spasticity, hyperreflexia, and clonus are features of phenytoin intoxication, present in this case, which are not commonly seen, and which have rarely been mentioned previously in the literature.

Adult↗
PubMedDate not supplied

Current concepts of surgical management of deformities of the lower extremities in cerebral palsy.

In cerebral palsy, principles involved in proper selection of orthopedic management of the lower limbs include diagnosis, timing, goals, degree of involvement, linkage, kinetic electromyography, retention of neonatal automatisms, and dynamic versus fixed deformity, as well as the physical plant and professional skills. Specific lower extremity problems in the hip, knee, ankle, and foot must be analyzed and management for each should be approached on a rational basis. Unsolved enigmatic problems of etiology, pathways of neonatal automatisms that impose abnormal posturing, neurophysiologic mechanisms of spasticity, athetosis, rigidity and ataxia, pathogenesis of contracture, linkage biomechanics, and the neurologic, including the biomechanical effects of surgical intervention, require special research programs.

Ankle Joint↗
PubMed1979

Neurogenic bladder dysfunction.

The combined use of cystometry and perineal electromyography permits the physician to detect abnormalities in the synchronization of bladder contraction and urinary sphincter relaxation. With each pattern of neurogenic bladder disease, the coordination between bladder and sphincter determines whether urinary tract problems will develop. Treatment is tailored to specific bladder and sphincter defects.

Humans↗
PubMed1996

The effect of intranasal fluticasone propionate on the diving reflex in patients with non-eosinophilic non-allergic rhinitis.

The usual nasal response to head submersion in aquatic mammals is an increase in resistance to airflow, the so-called "diving reflex". Although less well-developed in humans, it is nevertheless present. It is likely to occur due to a relative increase of parasympathetic over sympathetic control of the nasal vasculature. Non-eosinophilic non-allergic rhinitis is thought to be due to a similar imbalance and we have attempted to establish whether the diving reflex is abnormal in this condition and whether intranasal fluticasone propionate for 6 weeks has any effect in modifying the nasal response.

Administration, Intranasal↗
PubMed1987

Abnormal cardiopulmonary baroreflexes in normotensive young subjects with a family history of essential hypertension.

Cardiopulmonary baroreflex control of forearm vascular resistance (FVR) and arterial baroreflex control of heart rate were compared between 12 normotensive subjects with hypertensive relatives (group A, 19.4 +/- 0.2 years) and 12 normotensive subjects with no family history of hypertension (group B, 19.5 +/- 0.3 years). Cardiopulmonary baroreflexes were evaluated using lower body negative pressure (LBNP) at -20 mmHg, and arterial baroreflexes were measured by Oxford phenylephrine method. Resting arterial pressure, central venous pressure, heart rate, cardiac index, total peripheral resistance, and FVR were not different between the two groups. Arterial baroreflex slope (BS) and reflex increases in FVR during LBNP were significantly lower in group A than in group B (11.4 +/- 0.9 vs. 17.1 +/- 1.1 ms/mmHg, 37.7 +/- 8.1% vs. 86.5 +/- 18.7%, respectively). There was significant correlation between %FVR and BS (r = 0.59; p less than 0.01). These results suggest that both cardiopulmonary and arterial baroreflexes are impaired in normotensive young subjects with a family history of hypertension.

Adolescent↗
PubMed1996

Transient urodynamic dysfunction of infancy: relationship to urinary tract infections and vesicoureteral reflux.

PURPOSE: Urinary tract infections and vesicoureteral reflux are more common in male than female infants. Since these problems can result from voiding dysfunction, we obtained a detailed history of voiding patterns and urodynamic testing in infants with urinary tract infections in the first year of life. MATERIALS AND METHODS: We evaluated 39 male and 22 female infants, including 40 with primary vesicoureteral reflux and 21 with no reflux or obstruction. RESULTS: Voiding abnormalities were noted in 97% of the male and 77% of the female infants, including high voiding detrusor pressure of greater than 40 cm. water in 92% of the male and 66% of the female infants, residual urine greater than 2 ml./kg. in 13% of the male and 23% of the female infants, and detrusor hyperreflexia with filling pressure greater than 40 cm. water in a third of the male infants. Voiding detrusor pressure was significantly higher in male than female infants and in male infants with grade IV to V reflux than those with lower grades of reflux or no reflux. Followup urodynamic testing in 15 infants with high voiding detrusor pressure revealed resolution of detrusor hyperreflexia and improvement in post-void residual in all and decreased voiding detrusor pressure in 14. CONCLUSIONS: We coined the term transient urodynamic dysfunction of infancy to describe this constellation of abnormalities, which predisposes infants to urinary tract infections and vesicoureteral reflux but improves spontaneously. The higher incidence of urinary tract infections and reflux in male infants may be related to higher intravesical pressures.

Female↗
PubMed1998

A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants.

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome.

Cleft Lip↗
PubMed2005

"Off" gait freezing and temporal discrimination threshold in patients with Parkinson disease.

OBJECTIVE: To investigate the relationship between temporal discrimination threshold (TDT) and "off" period gait freezing (OGF) in patients with fluctuating Parkinson disease (PD). METHODS: TDT values were measured at the dorsum of the toes in 11 control subjects and 22 patients with PD with a wearing-off phenomenon (16 patients with OGF and 6 patients without OGF). RESULTS: During the l-dopa "off" period, TDT values increased abnormally in both patient groups but were significantly higher in patients with OGF than in those without OGF. A positive correlation was found between the severity of OGF and TDT values measured by different point stimulation. In patients with OGF, a single dose of l-dopa treatment normalized TDT values and ameliorated OGF. CONCLUSIONS: Dopa-responsive abnormal discriminative sensory processing may be a possible cause of "off" period gait freezing observed in patients with fluctuating Parkinson disease.

Aged↗
PubMed1987

Neuropathy in the Miller Fisher syndrome: clinical and electrophysiologic findings.

The clinical and electrophysiologic findings in 10 patients with Miller Fisher syndrome (ataxia, ophthalmoplegia, and areflexia) were reviewed. All patients had motor and sensory nerve conduction studies and EMG in the arm and the leg, and seven patients had cranial nerve conduction studies. Electrodiagnostic abnormalities were found in all patients and were characteristic of an axonal neuropathy or a neuronopathy with predominant sensory nerve changes in the limbs and motor damage in the cranial nerves. The pattern of abnormalities was distinct from the usual features seen in the major form of acute inflammatory polyneuropathy, the Guillain-Barré syndrome.

Action Potentials↗